Category: Statistics

BMC Emerg Med. 2025 Sep 23;25(1):184. doi: 10.1186/s12873-025-01361-2.

ABSTRACT

BACKGROUND/OBJECTIVES: Over the past 50 years, the concept of the golden hour of shock was established as one of the central tenets of emergency trauma medicine. A shorter duration of prehospital care correlates with a positive change in outcome in numerous studies. Dispatching by the public safety answering points has hardly been discussed to date. Thanks to improved vehicle safety, additional accident data is now available to the emergency call centers.

METHODS: We investigated the effects of third-party system emergency calls (TPS-eCalls), which have become mandatory in new passenger cars in the EU in 2018, on dispatching in the emergency medical services (EMS). For this purpose, we linked the data of a public-safety answering point (PSAP) and an EMS. All emergency service deployments from 01/01/2023 to 31/12/2023 were evaluated. N = 1546 rescue missions were dispatched after motor vehicle accidents (MVA), 111 after TPS-eCall-alerts, 1435 after conventional alerts.

RESULTS: Dispatching in the PSAP currently took longer after TPS-eCall alerts than conventional alerts (01:39 ± 01:40 min vs. 02:41 ± 02:01 min, p ≤ 0.001). The differences were only significant in the case of accidents involving ≤ 2 passengers.

CONCLUSIONS: TPS-eCall data will be available increasingly. The future expansion data availability offers the opportunity to include objective accident data (airbag deployment, number of occupants, change of velocity) in the dispatching process. Adequate technical connection can improve dispatching and shorten preclinical treatment, especially for complex events with more than 2 passengers.

PMID:40988067 | DOI:10.1186/s12873-025-01361-2

J Cannabis Res. 2025 Sep 23;7(1):67. doi: 10.1186/s42238-025-00334-3.

ABSTRACT

BACKGROUND: The evidence is mixed regarding how socioeconomic status (SES) it is related to cannabis use among adolescents. This study assessed the association between parental SES, measured as the highest level of completed education, and past 12 month cannabis use in older adolescents.

METHOD: Self-reported survey data from the first and second wave of a nationwide cohort study (Futura01) were used (n = 3328). Register information on parental education was linked to the survey data. Two measures of cannabis use were considered: any use during the past 12 months, and use 10 + times during the past 12 months. Control variables included demographics, family and school variables, conduct and emotional problems, and cannabis use at baseline. Multilevel Poisson regression was used to assess the associations.

RESULTS: Adolescents having parents with low SES had a lower risk for any cannabis use during the past 12 months, ranging from RR = 0.71 (95% CI = 0.49-1.01) in the unadjusted model to RR = 0.61 (95% CI = 0.42-0.87) in the most adjusted model compared to adolescents with parents having high SES. Compared to those with parents with high SES, those with parents with intermediate SES had lower risk for any cannabis use past 12 months, with RRs ranging from 0.79 (95% CI = 0.59-1.07) in the unadjusted model to RR = 0.71 (95% CI = 0.53-0.95) in the fully adjusted model. For use 10 + times, non-significant associations were observed.

CONCLUSION: Adolescents with parents with lower SES had a lower risk of any past 12 months cannabis use. For more frequent use, no statistically significant associations were observed.

PMID:40988061 | DOI:10.1186/s42238-025-00334-3

BMC Anesthesiol. 2025 Sep 23;25(1):450. doi: 10.1186/s12871-025-03374-7.

ABSTRACT

BACKGROUND: Intraoperative hemodynamic monitoring has advanced significantly over the past few decades, enhancing patient safety and improving perioperative outcomes. This survey aimed to examine current practices in intraoperative hemodynamic management in Austria.

METHOD: Between January 2024 and February 2024, members of the Austrian Society of Anesthesiology, Resuscitation, and Intensive Care Medicine (ÖGARI) with a registered email address (n = 1,839) were invited to participate in an anonymous web-based survey.

RESULTS: A total of 201 questionnaires were received, of which 177 were fully completed. When using intermittent oscillometry, 40% (71/177) of respondents measure blood pressure every three minutes during anesthesia induction. Nearly 45% (80/177) routinely insert an arterial catheter before anesthesia induction, using mean arterial pressure (MAP) to Guide blood pressure management. While 36% (61/168) consider a MAP of 60 mmHg critically low, 48% (80/168) set the threshold at 65 mmHg. Intraoperative hypotension is predominantly managed at individual discretion by 79% (140/177), while 12% (21/177) follow institutional standardized protocols. A pulse contour analysis monitor is available in 94% (166/177) of respondents, with 49% (87/177) reporting frequent use. Regarding the limited use of advanced hemodynamic monitoring in high-risk non-cardiac surgery patients, 64% (113/177) perceived its added value as too low, while 57% (100/177) cite a lack of experience in interpreting the parameters as a barrier to implementation.

DISCUSSION: This survey among ÖGARI members provides key insights into intraoperative hemodynamic monitoring in Austrian hospitals. The findings suggest that respondents largely follow international recommendations, particularly concerning general blood pressure thresholds, measurement intervals, and indications for advanced hemodynamic monitoring. However, hemodynamic management appear to be only partially standardized, with decisions primarily left to the discretion of the anesthetist.

TRIAL REGISTRATION: The study was prospectively registered in the German Clinical Trials Register (DRKS; registration number DRKS00033181 on December 6, 2023).

PMID:40988060 | DOI:10.1186/s12871-025-03374-7

BMC Oral Health. 2025 Sep 23;25(1):1419. doi: 10.1186/s12903-025-06903-5.

ABSTRACT

BACKGROUND: The cementation of indirect restorations is a critical step influencing their long-term clinical success. While dual-cure resin cements are widely used, injectable resin composites have emerged as promising alternatives, offering improved handling, high filler content, and esthetic stability. However, their clinical performance as luting agents for indirect restorations remains insufficiently explored. This trial assessed the clinical performance of indirect hybrid ceramic onlay restorations cemented with injectable resin composite versus dual-cure resin cement over 18 months.

MATERIALS AND METHODS: A total of 28 participants were randomly assigned to two groups (n = 14) based on the cementation protocol. The intervention group received onlays cemented with injectable resin composite (BEAUTIFIL Flow Plus X F03, Shofu Dental Corporation), while the control group received dual-cure resin cement (BeautiCem SA, Shofu Dental Corporation). Standardized procedures were followed for cavity preparation, immediate dentin sealing, cavity optimization, impression-taking, onlay fabrication (SHOFU Block HC, Shofu Dental Corporation), and cementation. Restorations were evaluated at baseline, 6, 12, and 18 months using the modified USPHS criteria. Data were statistically analyzed with significance set at P ≤ 0.05. Intergroup comparisons were assessed with Chi-squared test, while intragroup comparisons were assessed with Cochran’s Q test. Kaplan-Meier analysis and the log-rank test were used to evaluate survival rates.

RESULTS: Inter- and intragroup comparisons revealed no significant differences between the two groups for most outcomes (P > 0.05). However, at 18 months, dual-cure resin cement exhibited significantly higher marginal discoloration than injectable resin composite (P = 0.038). Within the dual-cure resin cement group, a significant decline in alpha scores for marginal discoloration was observed from baseline to 18 months (P = 0.007). While no restorations failed (Charlie score), Kaplan-Meier survival analysis and the log-rank test demonstrated a statistically significant difference between the two groups (P = 0.029).

CONCLUSIONS: After 18 months, injectable resin composite demonstrated acceptable and comparable clinical performance to dual-cure resin cement, with the added benefit of reduced marginal discoloration.

CLINICAL RELEVANCE: Injectable resin composites offer a viable alternative to dual-cure resin cements for luting indirect restorations with enhanced esthetic outcomes.

TRIAL REGISTRATION: https://clinicaltrials.gov/ , (NCT05954156), 20-07-2023.

PMID:40988059 | DOI:10.1186/s12903-025-06903-5

Genome Biol. 2025 Sep 23;26(1):298. doi: 10.1186/s13059-025-03724-1.

ABSTRACT

BACKGROUND: Neuropsychiatric disorders are highly complex conditions and the risk of developing a disorder has been tied to hundreds of genomic variants that alter the expression and/or RNA isoforms made by risk genes. However, how these genes contribute to disease risk and onset through altered expression and RNA splicing is not well understood.

RESULTS: Combining our new bioinformatic pipeline IsoLamp with nanopore long-read amplicon sequencing, we deeply profile the RNA isoform repertoire of 31 high-confidence neuropsychiatric disorder risk genes in Human brain. We show most risk genes are more complex than previously reported, identifying 363 novel isoforms and 28 novel exons, including isoforms which alter protein domains, and genes such as ATG13 and GATAD2A where most expression was from previously undiscovered isoforms. The greatest isoform diversity is detected in the schizophrenia risk gene ITIH4. Mass spectrometry of brain protein isolates confirms translation of a novel exon skipping event in ITIH4, suggesting a new regulatory mechanism for this gene in the brain.

CONCLUSIONS: Our results emphasize the widespread presence of previously undetected RNA and protein isoforms in the human brain and provide an effective approach to address this knowledge gap. Uncovering the isoform repertoire of candidate neuropsychiatric risk genes will underpin future analyses of the functional impact these isoforms have on neuropsychiatric disorders, enabling the translation of genomic findings into a pathophysiological understanding of disease.

PMID:40988056 | DOI:10.1186/s13059-025-03724-1

Eur J Med Res. 2025 Sep 23;30(1):849. doi: 10.1186/s40001-025-03123-z.

ABSTRACT

BACKGROUND: Approximately 50% of the women with polycystic ovary syndrome (PCOS) are overweight or obese and obesity can significantly impair reproductive function. This study aimed to investigate the association between body mass index (BMI) and embryonical/clinical outcomes in PCOS patients undergoing ultralong gonadotrophin-releasing hormone agonist (GnRH-a) protocol and to establish evidence-based management strategies for obese women with PCOS.

METHOD: A total of 1704 PCOS patients aged 20-42 years were treated with an ultralong GnRH-a protocol during a single oocyte retrieval cycle, followed by blastocyst transfer between 2016 and 2023. Participants were stratified according to BMI criteria into four groups: underweight (n = 125), normal weight (n = 845), overweight (n = 517) and obese (n = 217). Baseline characteristic and reproductive outcomes were compared across BMI categories.

RESULTS: PCOS patients with obesity exhibited a significant reduction in both the number of retrieved oocytes and mature oocytes. In fresh blastocyst transfer cycles, no statistical differences in live birth rates were observed across the four BMI groups (p = 0.246). However, in frozen-thawed blastocyst transfer cycles, the obese group had the lowest live birth rate among all BMI categories. Multivariate logistic regression analysis identified several key predictors of live birth. The number of high-quality blastocysts transferred was a dominant favorable factor (OR = 1.480, 95% CI 1.251-1.751). Conversely, obesity independently predicted a reduced likelihood of live birth (OR = 0.437, 95% CI 0.298-0.641). Further analysis of cumulative live birth outcomes in a complete oocyte retrieval cycle confirmed that obesity remained a negative predictor (OR = 0.438, 95% CI 0.312-0.615), while the number of high-quality blastocysts transferred (OR = 1.269, 95% CI 1.132-1.423) and a shorter duration of infertility (OR = 0.927, 95% CI 0.885-0.972) were associated with improved success rates.

CONCLUSIONS: PCOS patients with obesity presented poorer embryonical and clinical outcomes. Obesity emerged as a significant independent predictor of nonlive birth in both frozen-thawed blastocyst transfer cycles and complete in vitro fertilization (IVF) cycles. This study underscores the clinical importance of incorporating pre-IVF interventions, particularly weight management strategies, for obese PCOS patients to optimize reproductive outcomes.

PMID:40988053 | DOI:10.1186/s40001-025-03123-z

BMC Med Educ. 2025 Sep 23;25(1):1255. doi: 10.1186/s12909-025-07974-2.

ABSTRACT

BACKGROUND: Educational attainment and admission tests have a longstanding history in the selection of medical students and are often used simultaneously in selection processes. Their value in the admission process is most frequently assessed by their ability to predict academic performance in medical school. However, their simultaneous use may overlook an overlap in their predictive validity. The present study aims to assess the predictive validity of both educational attainment and admission tests, as well as their incremental validities. In addition, subtest analyses are conducted to gain a more profound understanding of admission tests’ predictive power.

METHODS: A survey amongst test-takers of the German admission tests was conducted in 2022 and 2023. Self-reported preclinical performance was matched with admission test scores (i.e., TMS and HAM-Nat). Educational attainment was assessed by high-school grade point average (GPA). Based on n = 2113 medical students, hierarchical multiple regression analyses were conducted. Pearson’s correlations were used to assess the relationship of subtests with academic performance. For all analyses, the effects of range restriction were diminished using a multivariate correction formula.

RESULTS: TMS and HAM-Nat as well as high-school GPA predicted academic performance separately. However, while both admission tests demonstrate substantial incremental validity over high-school GPA, the reverse is true to a far lesser extent. High-school GPA exhibits only small predictive power whilst controlling for admission test scores. Subtests containing elements of both crystallized and fluid intelligence proved to be of moderate effect size.

CONCLUSIONS: The findings of this study suggest that both admission tests and high-school GPA are well-suited as selection criteria in the admission process. Given the growing concerns regarding high-school GPA, admission tests emerge as a compelling alternative, particularly because of their stronger predictive power. Within each examined admission test, content-rich subtests containing elements of both crystallized and fluid intelligence demonstrated the strongest association with academic performance in preclinical years, in line with the test-criterion content match hypothesis.

PMID:40988052 | DOI:10.1186/s12909-025-07974-2

Pharmacoepidemiol Drug Saf. 2025 Oct;34(10):e70213. doi: 10.1002/pds.70213.

ABSTRACT

PURPOSE: Linking claims data to electronic health record (EHR) data can improve completeness, often at a cost of decreased sample size. Quantifying information gained and differences in patient characteristics between EHR and EHR-claims linked cohorts may inform study design.

METHODS: Using ConcertAI Patient360 EHR linked to multiple closed insurance claims sources, we compared an EHR cohort of patients with incident metastatic breast cancer (mBC) to an EHR-claims subcohort (requiring ≥ 90 days claims coverage). We analyzed diagnosis coverage, patient time during lookback and follow-up, baseline characteristics, and rates of 14 adverse events (AEs). Analyses were age stratified due to insurance coverage changes at age 65.

RESULTS: For the EHR cohort (N = 6289), 1438 (23%) were in the EHR-claims subcohort. A greater proportion were aged ≥ 65 years in the EHR cohort (30%) than in the EHR-claims subcohort (17%). EHR-claims patients had longer observation periods and more unique diagnoses across both age groups. For most AEs, incidences were higher in both age groups in the EHR-claims subcohort than in the EHR cohort.

CONCLUSIONS: EHR-claims provided more diagnoses and observation time, at the cost of a reduction in sample size and underrepresentation of patients ≥ 65 years. Differing age proportions support age-stratified or standardized analyses for EHR-claims data. Results aid interpretation of differences between EHR and EHR-claims results due to shifts in age, completeness of diagnosis history, and duration of observation.

PMID:40988051 | DOI:10.1002/pds.70213

Lipids Health Dis. 2025 Sep 23;24(1):286. doi: 10.1186/s12944-025-02710-7.

ABSTRACT

BACKGROUND: Metabolic dysfunction-associated steatotic liver disease (MASLD) represents a growing public health challenge in Egypt, driven by westernized dietary patterns, urbanization, and physical inactivity. Despite lifestyle intervention being the first-line management, data on structured hypocaloric diets tailored to Egyptian patients remain limited, particularly regarding their effects on hepatic steatosis, inflammatory pathways, and oxidative stress biomarkers. This study aimed to evaluate the impact of a culturally adapted 6-month hypocaloric diet on hepatic fat reduction, metabolic parameters, inflammatory-oxidative biomarkers, and lifestyle factors in Egyptian MASLD patients, with additional exploration of weight-independent mechanisms.

METHODS: In this single-center interventional trial, 30 newly diagnosed MASLD patients received a personalized hypocaloric diet (500-1000 kcal/day deficit). Outcomes measured at baseline and post-intervention included anthropometrics, liver enzymes, metabolic profile, hepatic steatosis (CAP score), inflammatory markers (TNF-α, MDA), antioxidant enzymes (SOD, CAT), and lifestyle behaviors (physical activity, sleep). Advanced statistical analyses included effect size estimation, multivariate regression, mediation analysis, and subgroup comparisons (lean vs. obese MASLD).

RESULTS: After 6 months, patients achieved significant reductions in weight (- 10.9 kg), BMI (- 3.9 kg/m²), and CAP score (- 89.5 dB/m) (all P < 0.001). Liver enzymes improved significantly, with ALT decreasing by – 22.2 U/L and AST by – 21.3 U/L (both P < 0.001). TNF-α (- 88.2 pg/mL, baseline 166.1 pg/mL) and MDA (- 1.1 nmol/mL, baseline 2.7 nmol/mL) decreased markedly, with large effect sizes (CAP: d = 1.9; TNF-α: d = 2.1; MDA: d = 1.4). Antioxidant biomarkers improved significantly, with SOD increasing by 209% (d = 1.8) and CAT by 48.5% (d = 1.2) (both P < 0.001). Although BMI and weight loss were strongly associated with hepatic fat reduction, TNF-α reduction remained an independent predictor of CAP improvement (β = 0.31, P = 0.02), mediating 32% of the diet’s effect after adjusting for BMI. Patients achieving ≥ 5% weight loss were 4.2 times more likely to experience ≥ 10% CAP score reduction. Lean MASLD patients (n = 6) exhibited greater improvements in hepatic fat and inflammation despite less weight loss; however, these findings should be interpreted with caution due to the small subgroup size. Dietary adherence strongly correlated with CAP reduction (r = – 0.71, P < 0.001) and antioxidant gains.

CONCLUSION: A culturally tailored hypocaloric diet effectively improved hepatic steatosis, inflammatory status, and antioxidant capacity in Egyptian MASLD patients. These improvements were partially weight-independent and partially mediated by anti-inflammatory responses. These findings support hypocaloric dietary strategies as a potentially scalable therapeutic option for MASLD management in resource-limited settings, though the absence of a control group limits causal inference, and further evaluation of implementation feasibility and cost-effectiveness is warranted. Additional benefits were also observed in lifestyle behaviors such as physical activity and sleep.

PMID:40988029 | DOI:10.1186/s12944-025-02710-7

Int J Emerg Med. 2025 Sep 23;18(1):169. doi: 10.1186/s12245-025-00967-4.

ABSTRACT

BACKGROUND & AIM: Analysis of heart rate variability metrics has shown added accuracy in pre-hospital trauma triage. These metrics include heart rate variability (HRV), meaning oscillations in the time interval between heartbeats, and heart rate complexity (HRC), which assesses intricate patterns of heart rate over time. This review article evaluates current knowledge regarding HRV and HRC and prediction of a subsequent life-saving intervention (LSI), an intervention executed by trained medical personnel to prolong the life of the patient. Our primary focus was on pre-hospital patients and the utility of HRV and HRC when added to existing trauma triage scores or vital signs such as heart rate (HR).

METHODE: A literature search was carried out by searching the MEDLINE database via the PubMed website for original research published in English from 2008 to 2023. The combinations of search terms applied yielded 18 original studies of which only six met our criteria. We included another study as it contributed original research beneficial to our article.

RESULTS: The studies showed a statistically significant increase in the ∆Area Under Curve (AUC) between 0.14 and 0.40 for predicting risk of LSI when adding the two heart rate variability metrics to existing trauma triage scores or vital signs such as HR. Calculation of HRV and/or HRC could be conducted using ECG recording hardware already accessible in most emergency pre-hospital settings with less ECG noise and therefore higher quality ECG data over time.

CONCLUSION: Both HRV and HRC showed potential for increasing ∆AUC in predicting risk of LSI when added to existing risk triage scores. Calculation of HRV and HRC could potentially be conducted using a preexisting hardware in most emergency pre-hospital settings.

PMID:40988025 | DOI:10.1186/s12245-025-00967-4